Basic Information
| Provider Information | |||||||||
| NPI: | 1679602155 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WHITES ADVANCED HEARING AID SYSTEMS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WHITE MUSSELMAN HEARING AID CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 408 S JEFFERS ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691015350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085325114 | ||||||||
| FaxNumber: | 3085321996 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 S JEFFERS ST | ||||||||
| Address2: | |||||||||
| City: | NORTH PLATTE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691015350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3085325114 | ||||||||
| FaxNumber: | 3085321996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3085325114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | H.A.D.F. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332S00000X | 220 | NE | Y | Suppliers | Hearing Aid Equipment |
No ID Information.